The UK government has published new terms for its statutory scheme of pharmaceutical rebates, maintaining historically high rates that will require drugmakers to pay 21.9% of their branded medicine sales to the National Health Service (NHS) in 2024, rising to 24% in 2025 and 26.8% in 2026.
This announcement comes shortly after the government reached what was described as a landmark agreement with the industry on the alternative voluntary scheme, creating what the Association of the British Pharmaceutical Industry (ABPI) calls "mixed messages" about the UK's commitment to life sciences investment.
"This announcement sends a very confusing message to global life sciences investors," said ABPI chief executive Richard Torbett. "The new Voluntary Scheme agreement shows that the government realizes that capping the UK medicines market below its natural growth is unsustainable – yet this Statutory Scheme continues to do so, resulting in damaging headline rebate rates which undermine the UK in the eyes of investors."
Understanding the UK's Pharmaceutical Rebate Schemes
The UK operates two parallel systems to control NHS spending on branded medicines: the voluntary scheme, soon to be renamed the Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG), and the statutory scheme, which applies to manufacturers who opt out of the voluntary arrangement.
Both schemes require pharmaceutical companies to pay a percentage of their UK revenues back to the government if NHS drug expenditure rises above predetermined thresholds. Medicines represent the second-highest proportion of NHS spending, valued at approximately £27 billion in England for the 2023-2024 financial year, with £18.6 billion spent specifically on branded medicines.
The rebate rates have risen dramatically in recent years, reaching a record 27.5% in 2023, prompting major pharmaceutical companies including AbbVie and Eli Lilly to withdraw from the voluntary scheme earlier this year in protest of what they described as "punitive clawbacks."
International Comparisons Raise Competitiveness Concerns
The ABPI highlights that the UK's rebate rates far exceed those of comparable European markets. Germany currently operates with a 12% rebate rate, while Spain and Ireland maintain rates of 7.5% and 8.25%, respectively.
Industry representatives argue that maintaining such high rates will damage the UK's attractiveness for life sciences investment at a time when the government has publicly stated ambitions to position the country as a global leader in pharmaceutical research and development.
Abandoned Life Cycle Adjustment Mechanism
One positive development for the industry was the government's decision to abandon its earlier plan to introduce a 'life cycle adjustment' (LCA) mechanism, which would have applied different rebate rates to branded medicines based on their age and market competition.
The ABPI had warned that this mechanism would have been unworkable and likely would have resulted in low-margin branded medicines being withdrawn from the UK market. However, the government has indicated it remains "committed to the principle of ensuring sustainable spending on older branded medicines" and plans to consult again on the matter in 2024.
Implications for the UK Pharmaceutical Landscape
The divergence between the newly agreed voluntary scheme and the maintained high rates in the statutory scheme creates a complex decision for pharmaceutical companies operating in the UK. Manufacturers must choose which scheme they will join for the coming year before the end of 2023.
The pharmaceutical industry has consistently argued that excessive rebate rates threaten inward investment into the UK life sciences sector, potentially impacting research funding, clinical trials, and ultimately patient access to innovative medicines.
As the UK government attempts to balance NHS budget constraints with ambitions to foster a thriving life sciences sector, this latest announcement suggests that tensions between fiscal prudence and innovation incentives remain unresolved.
For patients and healthcare providers, the long-term implications of these policies may determine not only the sustainability of the NHS medicines budget but also future access to new therapies and the UK's position in global pharmaceutical research and development.
